What factors influence surgical decisions for post-NEC intestinal strictures in a 14-year, 325-case cohort?

This study aimed to identify preoperative factors associated with stoma use in infants with post-NEC intestinal strictures and to develop a pragmatic model estimating the probability of staged stoma strategy selection. A retrospective cohort of 325 infants who underwent surgery for NEC-related strictures at a single center (2010–2024) was analyzed. Preoperative variables were evaluated using LASSO logistic regression and multivariable modeling. Four independent predictors associated with stoma use were identified: hematochezia, elevated CRP (> 8 mg/L), higher preoperative WBC, and lower weight at surgery. The model demonstrated good discrimination (AUC 0.814), with temporal validation AUC of 0.779. Preoperative inflammatory burden and lower weight at surgery were associated with stoma use in infants with post-NEC intestinal strictures. The model may support preoperative counseling and surgical planning, but should be interpreted as estimating the probability of stoma strategy selection in our institutional practice rather than defining objective indications for either stoma formation or primary anastomosis.